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The urgency of healthcare interoperability
Doctor at desk looking at x-rays
Overview

Now is the time to rethink the way we work in healthcare—to design experiences with people at the heart. IBM believes in embracing a human-centered experience approach as we accelerate the adoption of digital capability into care systems.

Amid digital transformation, healthcare organizations must work to unify fragmented systems, policies and processes to drive better patient outcomes, regulatory compliance and overall efficiency. Simultaneously, they must prepare for industry shifts to advance their competitive position, improve employee and patient experiences and drive revenue.

IBM healthcare consultants with deep industry expertise serve as experienced guides to help design and implement successful programs through a comprehensive approach, from performance improvement and resource management to patient experience. Our healthcare consulting team can help design a technology roadmap that addresses urgent needs and emerging requirements. By developing smart and flexible strategies for both technology and processes, you can exceed current expectations and experience true business transformation.

Reducing administrative burden in the healthcare industry with AI and interoperability.

Get all the latest insights in our Healthcare Consulting blog

Benefits 90-95% Provide more accurate information, when it's needed

Servicing administrative staff at healthcare providers achieved a 90-95% accuracy rate when accessing pre-service, medical eligibility, verification, authorization and referral information.1

5M+  Deliver exceptional member and provider experiences

Elevance Health reduced annual contact center calls by over 5 million after deploying AI-driven chatbots..2

27% Reduce app service costs

Providence identified opportunities to reduce their annual application service costs by 27%, all without compromising app performance.3

Digital transformation journey: Payers Generative AI for a reimagined member experience 

Generative AI provides a unique opportunity to reimagine how payers deliver care services and engage members, improve patient and member access to trusted information, and troubleshoot common questions and issues.

Read the CEO's guide to generative AI
Integrated healthcare experiences   

Hybrid cloud and AI can enable richer, more connected omnichannel experiences while lowering the cost of human interactions with health plan and health system constituents, including members, providers, brokers, employers, patients and consumers.

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Skills of the future

IBM Consulting® works closely with clients to tailor solutions specific to their recruiting and skill needs, providing customized strategies across consulting, technology and managed services.. Clients might include those who are looking to address high turnover, enhance the recruiting technology stack, improve workforce productivity, address skills shortages or create an effective learning experience for a diverse workforce.

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Digital transformation journey: Providers Healthcare platform services

Gain insights to deliver more personalized care through a holistic view of the patient and caregiver by establishing an interoperable, democratized and trusted view of healthcare data across the healthcare continuum. Integrate clinical and nonclinical patient data from across vendor systems that can expose the data through FHIR or other formats and exchange protected health information within a trusted network to maintain compliance with all applicable laws.

 

Healthcare experience transformation

To successfully transform through design, we must consider the whole service pathway as experienced by an end user, both physical and digital.

Hospital modernization

Transform care through smarter, more digitally enabled and connected hospitals that improve patient outcomes at its core. Enable hospitals to operate efficiently and profitably through automated workflows that allow clinicians to spend more time on providing care versus in clinical documentation or accessing patient information. Empower those clinicians to accurately diagnose patients and define appropriate care pathways by using emerging technologies and advanced insights.

Case studies
University Hospitals Coventry and Warwickshire NHS Trust

UHCW NHS Trust joins with IBM Consulting and IBM Business Partner Celonis SE to use IBM watsonx.ai technology to help drive more efficient patient care.

Humana

Humana reduced costly pre-service calls and improved the provider experience with conversational AI.

Cleveland Clinic

Cleveland Clinic and IBM have unveiled the first quantum computer dedicated to healthcare research. Researchers and partners will advance biomedical science and treatment while fostering the next-generation technology workforce for healthcare.

Providence

Providence reduces their cloud app service costs by 27% while accelerating their ability to provide better care experiences through a more modern technology infrastructure.

University Hospitals Coventry and Warwickshire (UHCW) NHS Trust

Utilizing IBM® watsonx.ai™ technology, UHCW NHS Trust enhanced patient-centered care delivery by serving over 700 more patients weekly, experiencing a 6% drop in missed appointments for some patients.

Insights
The urgency of healthcare interoperability

When applications, devices and systems can interact and exchange healthcare information in real time, healthcare providers can operate more efficiently, streamline the patient experience and provide more personalized patient care.

The case for interoperability, Part I: Driving return on investment for payers

There's tremendous untapped ROI potential in being able to make interoperable data actionable. The recent legistlation from Centers for Medicare and Medicaid Services (CMS) on interoperability and price transparency suggests payers must check yet more regulatory boxes in order to be compliant with the government.

The case for interoperability, Part II: What is the right FHIR for you?

With the introduction of Fast Heathcare Interoperability Resources (FHIR), healthcare now has a standard and a technology that forms a common language between payers and providers, centered on the patient. In this paper, learn about the current FHIR implementation patters we're seeing within healthcare information technology (HIT) platforms.

The next frontier for prior authorization

A “perfect storm” has been brewing among payers, providers and regulators on prior authorization, and, more broadly, utilization management programs. A convergence of regulatory action, member dissatisfaction, clinician burnout, economic turmoil and rising costs of care has created a tremendous amount of pressure for payers and providers that is likely to ignite in the coming months.

The CEO's guide to responsible AI and ethics

How can companies protect sensitive data? How can they use AI in a manner that respects copyrights? Understand more about how human values are at the heart of responsible AI.

Elevance Health and IBM deliver exceptional AI experiences

Elevance Health has been on a mission to deliver exceptional digital-first, AI-first experiences. Today, members of Elevance Health’s affiliated health plans can reach the health plan 24x7 by using their award-winning Sydney Health mobile app, Anthem.com website or switch to SMS from the IVR itself.

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Ensure your patients and organizations have the right safeguards and responses in place. Since 2020, healthcare data breach costs have increased 53.3%. Healthcare also has the highest average cost of a breach at over USD 10 million.4

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Business process outsourcing  

Rethink operations to enable the healthcare models of the future. An outcomes-based business process outsourcing model lends itself to the optimization of essential processes so you can accelerate transformation and performance. These processes include marketing, customer support, human resources, finance, procurement and supply chain management.

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Meet our experts Andrew Cohen, Global Leader of IBM’s Global Healthcare COE consulting practice

Andrew leads the vision, strategy, operation and execution of IBM Healthcare Consulting’s advisory services for the payer and provider industry segments, bringing over 30 years of healthcare industry experience. Prior to IBM, Andrew served in various executive leadership roles over the last 25 years for some of the nation’s largest health plan companies. He led national payer contracting and strategy divisions for 3 national health plans, and started, built, scaled and operated commercial and government program health plans focusing on value-based care. 

See Andrew's profile
Patrick Spoletini, Vice President and Consulting’s Healthcare Industry Leader for North America, IBM Consulting

Patrick Spoletini is the Healthcare Industry Leader for North America with over 30 years of healthcare industry (payer and provider) and management consulting experience, ranging from strategy, operations and change management to regulatory compliance with contract negotiations, digital transformation, managed services, BPO and large-scale program management. 

See Patrick's profile
Dr. Angela Spatharou, Senior Partner and Leader, EMEA Healthcare & Life Sciences, IBM Consulting

Dr Angela Spatharou has over 20 years of experience working with leading health systems, hospitals, health insurers, digital health innovators and life science companies. She has worked in the UK and across EMEA, and in the US and Latin America, to increase value, improve outcomes and help deliver sustainable improvements.

See Angela's profile
Mark Davies, Chief Health Officer, IBM

With over 25 years of experience as a clinician in the NHS, Mark’s focus is in the power of health technology to deliver better health outcomes. This has led him to work nationally for over 10 years in several leadership roles in the UK government. He has international experience in the technology industry and government health digital strategies.

See Mark's profile
Vincent Tay, Partner, Public Sector & Healthcare Leader APAC

Vincent is a maven in the arena of information technology consulting and business transformation with more than 20 years of industrial experience. He has led teams in championing large and complex transformational projects across the ERP industry, cloud service providers and low-code application development platforms. 

See Vincent's profile
Deiva Ramachandran, Generative AI Leader

Deiva leads the industry point of view for life sciences, healthcare, and state and local Government for how generative AI and automation will transform human experiences, simplify and drive enterprise efficiencies and create new value from data.

See Deiva's profile
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